Gastrointestinal endoscopy · 2025
Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions.
СтатьяВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Vu Trung Kien, Abou-Ali Einas, Gulla Aiste, Soares Kevin, Caillol Fabrice, Paik Woo H, Napoleon Bertrand, Halimi Asif, Masaryk Viliam, Bruno Marco J, Pérez-Cuadrado-Robles Enrique, Bolm Louisa, Seyfried Steffen, Petrone Maria C, Yilmaz Bengisu, Vollmer Charles, Berger Arthur, Maggino Laura, Schemmer Peter, Wichmann Dörte, Karam Elias, Dugic Ana, Kunovsky Lumir, Regner Sara, Gaujoux Sebastien, Hollenbach Marcus, ESAP Study Group
Аннотация
BACKGROUND AND AIMS: Endoscopic papillectomy (EP) is the standard treatment for noninvasive ampullary lesions (ALs), whereas advanced cases require surgery. Managing ALs is challenging and may lead to over- or undertreatment. We developed a score to identify the best candidates for endoscopic or surgical treatment.
METHODS: We analyzed 447 patients who underwent EP. The cohort was randomly split into a training set (n = 325) and validation set (n = 122). Logistic regression identified predictors for incomplete resection (R1), which were incorporated into a 4-item score. Performance was assessed using the area under the receiver-operating characteristic curve (AUROC).
RESULTS: Independent predictors for R1 included size ≥30 mm (S), high-grade dysplasia and/or invasive cancer (D), laterally spreading-lesion (L), and bile or pancreatic duct dilation (D), which we named the SDLD score. ALs with 0 to 1 points had the highest complete resection rates (training, 86.0%; validation, 88.5%), whereas ≥2 points significantly increased R1 rates (training, 52.0%; validation, 57.7%; P < .001). The AUROC was 0.792 (training) and 0.708 (validation).
CONCLUSIONS: The SDLD score predicts R1 in EP and aids in treatment decisions.
METHODS: We analyzed 447 patients who underwent EP. The cohort was randomly split into a training set (n = 325) and validation set (n = 122). Logistic regression identified predictors for incomplete resection (R1), which were incorporated into a 4-item score. Performance was assessed using the area under the receiver-operating characteristic curve (AUROC).
RESULTS: Independent predictors for R1 included size ≥30 mm (S), high-grade dysplasia and/or invasive cancer (D), laterally spreading-lesion (L), and bile or pancreatic duct dilation (D), which we named the SDLD score. ALs with 0 to 1 points had the highest complete resection rates (training, 86.0%; validation, 88.5%), whereas ≥2 points significantly increased R1 rates (training, 52.0%; validation, 57.7%; P < .001). The AUROC was 0.792 (training) and 0.708 (validation).
CONCLUSIONS: The SDLD score predicts R1 in EP and aids in treatment decisions.